Black is the most fatal form, and is so called because, while the ordinary rash is fcanty, there is an eruption of dark-blue, violet, ar black spots. These are due to bleeding that bas taken place into the skin, and in some cases blood is lost from the nose, mouth, and other parts. Such cases are accompanied by delirium and high fever and rapidly end in death.
Treatment of Small - in other fevers with rash, no attempt need be made to arrest or cure an attack of small-pox. It will run its own course. The patient should be placed in a large well-ventilated room. The patient must not be heavily covered. His body and his bed should be kept as clean as possible; sponging with lukewarm water may be adopted, or the warm lysol bath, advised on p. 608, and the bed-sheets should frequently be changed. The skin may be anointed, after bathing, with carbolic oil or vaseline. Mutton broth, milk, beef-tea, &c., should be given in small quantities frequently. Lemonade, or gingerade, or acid drinks made with dilute sulphuric acid are grateful. If delirium and excitement are great, lukewarm baths are of use, and antipyrin in 2k-grain doses for chil dren and 5 for adults every three or four hours. The attendants should have been vac cinated. A patient who recovers must not be allowed to mix with other persons till all crusts and scales have disappeared, and till daily baths for a week have been taken. The utmost care must be taken to prevent the spread of the disease, as advised on p. 517. During a small pox epidemic all unvaccinated persons should be vaccinated, and among those who have been vaccinated, but as long before as seven years, re-vaccination should be practised.
Note.—If a person has been exposed to small-pox, and is immediately vaccinated, he may escape altogether. He may even escape if vaccinated within three days. If he puts off till the fourth day, he will pro bably take the disease, but it will be modi fied. Vaccination later than the fourth day after exposure is valueless.
Small - pox as altered by Vaccination (Modified Small-pox—Ilorn-pox).—While cination, if properly performed, as a general rule protects from small-pox, yet a vaccinated person may take the disease; but it does not run the ordinary course, and the risk attending it is slight. In the same way a person who
has had small-pox is protected, as a general rule, from a second attack. Yet cases do occur where the disease attacks for the second time, and in this case also it does not run its full course. In both cases the disease is altered. It is, nevertheless, the same disease, for if a person suffering from the altered form municates the disease to an unvaccinated son, in that person it will appear in the nary unaltered form. A vaccinated person suffering from a mild attack of small-pox may thus communicate the disease in its most vated form to an unvaccinated person. tion is shown on Plate XXVIII.) The symptoms of altered small-pox are up to a certain point similar to those described under distinct small-pox. The symptoms at the beginning are the same—shivering, fever, pains in the back, vomiting—but they are milder. The eruption conies out about the same time—the third or fourth day—but the pimples are few in number. They suddenly cease to progress in the usual way, and soon disappear. Or the eruption comes out as usual, progresses to the stage of forming blebs, and then dries up without any fever or suppuration. Even when the pocks reach a more advanced stage, swelling of the face, of the hands and feet, and other symptoms of the bad forms of small-pox are scarcely ever seen in small-pox altered by vaccination. In short the disease never gets a proper hold of the person. It may flourish for a few days, but speedily loses its hold and convalescence begins. Just as some seeds sown in .particular kinds of soil may never produce good fruit, because the soil is deficient in the particular kind of nourishment they need, so that they spring up and progress to a certain stage only to wither away, so, in a person who has had small-pox previously, or has been vaccinated, there seems to be a want of the particular elements in the blood and body on which the small-pox poison flourishes. They either are, on that account, unable to take a second attack, or, if they take it, the disease advances only a little way and then abruptly terminates.